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This study examined the health-related quality of life (HRQOL) of children with Inflammatory Bowel Disease (IBD) compared with physically healthy children and the impact of IBD and steroidal side-effects on children's HRQOL. The HRQOL of 49 children and adolescents (ages 10 to 18 years) with IBD and their parents who completed the Child Health Questionnaire (CHQ; Landgraf & Abetz, 1997; Landgraf, Abetz, & Ware, 1996) was compared to that of a sample of physically healthy children (N = 49). Caregivers of children with IBD reported that their children's physical and psychological health were more limited and that they experienced more emotional worry and greater impact on their personal time compared to caregivers reporting on healthy same-age children. Children and adolescents reported worse HRQOL than physically healthy children in only one domain: general health. Children and adolescents with more IBD-related and steroidal symptoms had less adequate HRQOL as reported by their parents. Limitations in HRQO...

The effects of prenatal cocaine use on quality of maternal-infant interactions were evaluated using the Nursing Child Assessment Feeding Scale (NCAFS). A total of 341 (155 cocaine using; 186 non–cocaine using) low socioeconomic, primarily African-American dyads were evaluated longitudinally at birth, 6.5, and 12 months. Group differences over time were examined, controlling for covariates, using a mixed-model linear approach. Women who used cocaine during pregnancy were less sensitive to their infants than non–cocaine-using women at 6.5 and 12 months. At 6.5 months, heavier prenatal cocaine users were less responsive to their infants than lighter users. In infants, prenatal cocaine exposure was related to poorer clarity of cues. There were no significant cocaine effects on maternal social-emotional growth fostering, cognitive growth fostering, or infant responsiveness to mother. Controlling for covariates, concentration of cocaine metabolites predicted maternal sensitivity to infant cues and infant clarity of cues at 1 year. Maternal cocaine use during pregnancy and other pre- and postnatal factors adversely affect maternal-infant interactions during the first year of life.

Data are equivocal regarding the long-term consequences of prenatal exposure to cocaine on school-aged children. We compared 101 children exposed prenatally to cocaine with 130 unexposed children on measures of intelligence, visual motor, and motor abilities at age 7 years. Bivariate analyses revealed that cocaine-exposed children scored significantly lower than comparison children on the abbreviated Wechsler Intelligence Scale for Children-Third Edition Verbal and Full Scale IQ scores, the Visual Motor Integration and Motor Coordination standardized scores, and the Bruininks-Oseretsky Fine Motor Composite score. Regression analyses indicated that the biological mother's vocabulary and home environment assessed at the same 7-year visit were stronger predictors of developmental outcome than prenatal drug exposure. Level of cocaine exposure, however, predicted visual motor and motor skills. The results indicate that although prenatal cocaine exposure may confer some degree of developmental disadvantage in the visual motor domain, it frequently occurs in the context of an inadequate rearing environment, which may be a stronger determinant than prenatal cocaine exposure of children's outcome. J Dev Behav Pediatr 25:83-90, 2004. Index terms: cocaine, development, children, caregiving environment.

To assess teratogenic effects of cocaine exposure and maternal psychological distress on birth outcomes, we conducted a longitudinal prospective study of 415 infants (218 cocaine-exposed--CE, 197 nonexposed--NE). Drug exposure was determined through a combination of maternal self-report, urine, and meconium screens. Maternal psychological distress postpartum was evaluated through a standardized, normative, self-report assessment. An extensive set of confounding variables was controlled, including severity of exposure to alcohol, tobacco, marijuana and other drugs, maternal age, race, parity, number of prenatal care visits, educational, marital, and socioeconomic status, and verbal and nonverbal intelligence. CE infants were smaller on all birth parameters and more likely to be preterm, small for gestational age, and microcephalic than NE infants. Forty-one percent of cocaine users had clinically significant psychological symptoms, compared to 20% of a high-risk comparison group of noncocaine users. Consistent with a teratologic model, cocaine exposure independently predicted offspring birthweight, length, and head circumference. Maternal psychological distress self-reported postnatally also independently predicted head circumference. Tobacco, alcohol, and marijuana exposures were also significant independent predictors of some fetal growth parameters. In addition, maternal distress symptoms, which may be reflective of maternal mental health disorders or responses to stress, added significantly to the risk for poorer fetal growth.

Objective. To assess whether there is an association of level of fetal cocaine exposure to developmental precursors of speech-language skills at 1 year of age, after controlling for confounding factors. Design. In a prospective, longitudinal, quasi-experimental, matched cohort design, 3 cocaine exposure groups were defined by maternal self-report and infant meconium assay: nonexposure (n = 131), heavier exposure (n = 66), >the 75th percentile for maternal self-report and >the 70th percentile of benzoylecgonine concentration, and all others as lighter exposure (n = 68). At 1 year of age, the Preschool Language Scale-3 was administered by examiners unaware of infant drug status. Results. Independent of confounding drug, medical, and environmental factors, more heavily exposed infants had lower auditory comprehension scores than nonexposed infants and lower total language scores than lighter and nonexposed infants. More heavily exposed infants were also more likely to be classified as mildly delayed by total language score than nonexposed infants. There were positive linear relationships between the concentration of benzoylecgonine in meconium and all outcomes and between maternal report of severity of prenatal cocaine use with poorer auditory comprehension indicating a relationship between amount of exposure and poorer outcomes. Conclusions. This study documents significant behavioral teratogenic effects of fetal cocaine exposure on attentional abilities underlying auditory comprehension skills considered to be precursors of receptive language. Pediatricians are in a unique position to monitor early development of cocaine-exposed infants and make timely referrals for intervention.

Objective. This article was designed to investigate effects of prenatal cocaine exposure on motor development of young children from a predominately underprivileged, urban population. Methodology. A total of 260 infants and young children were initially recruited from either the newborn nursery or the at-risk pediatric clinic of an urban teaching hospital. Prenatal history and birth outcomes were collected from medical records. Demographic characteristics and additional drug histories were obtained from the mothers. The 199 subjects (98 cocaine-exposed and 101 unexposed) who returned at age 2 years were assessed by examiners blinded to drug exposure status using the Peabody Developmental Motor Scales. Results. Compared with control subjects, the cocaine-exposed group performed significantly less well on both the fine and the gross motor development indices. Mean scores for both groups were within the average range on the gross motor index, but greater than 1 standard deviation below average on the fine motor index. Differences were significant on the balance and the receipt and propulsion subscales of the gross motor scale, and on the hand use and the eye–hand coordination subscales of the fine motor scale. Cocaine status independently predicted poorer hand use and eye–hand coordination scores. There also was an effect of alcohol exposure on the receipt and propulsion subscale. Conclusions. Findings indicate that deficiencies in motor development remain detectable at 2 years of age in children exposed to drugs prenatally. Although other environmental variables may influence motor development, children exposed to cocaine and to alcohol in utero may encounter developmental challenges that impede later achievement.

This study investigated effects of prenatal cocaine exposure on infant sensorimotor development. One hundred and sixty-seven 12-month-olds (74 cocaine-exposed and 93 unexposed) were assessed using the Bayley Scales of Infant Development (BSID). Ninety-seven had previously been evaluated on the Movement Assessment of Infants and the Test of Sensory Functions in Infants at age 4 months. On the BSID, the cocaine-exposed infants performed less well on the Mental portion and were more frequently rated as behaviorally suspect. Cocaine-exposed infants also performed less well at four months on the motor and sensory measures. Early motor performance predicted 12 month BSID mental, motor and behavioral outcomes. Cocaine exposure had an effect independent from confounders on general cognitive and specific motor and behavioral outcomes.

Research on animal models demonstrates that fetal cocaine exposure results in neurologic deficits in memory and learning. Although drug effects on human infants are difficult to separate from other environmental influences of a drug-using lifestyle, studies suggest that infants exposed to cocaine in utero have reduced growth, delays in sensory-motor development, attentional deficits, and depressed responsivity to social stimulation. Standard interventions to promote behavioral state regulation in affected infants may be helpful when parents are capable of participating.

This study investigated psychological symptoms, self-reported postpartum by poor, primarily African American women who used cocaine during pregnancy. Ninety-nine cocaine-using mothers (COC+) were compared to 44 noncocaine-using mothers (COC-) on standardized measures of psychological distress and verbal comprehension. Mothers were interviewed to determine extent of drug involvement. COC+ mothers reported using alcohol, marijuana, and tobacco at two to three times the rate of comparison mothers during pregnancy and reported earlier initiation of marijuana use. COC+ women were more likely to admit to interpersonal difficulties and to report phobic anxiety and paranoid ideational symptoms. The COC+ group was also more likely to have clinically elevated scores on subscales indicating feelings of personal inadequacy, phobic anxiety, and paranoia. The use of cocaine, in combination with either alcohol or marijuana, was the best predictor of psychoticism, hostility, and total number of distress symptoms.

The United States has recently been compelled to acknowledge and to cope with an alarming increase in incidence of drug exposure in newborns owing to a new cocaine epidemic. Perhaps because of the sudden onset of national recognition of the problem, the lack of a firm knowledge base regarding the mechanisms of the effects of cocaine on child development, and the sheer magnitude of the problem in urban areas of the United States, the issue of cocaine exposure in children has been characterized by medical, legal, and social policy controversies. This article focuses on elucidating what is and what is not known about cocaine’s neurodevelopmental effects and aims to inform perinatologists about the complex issues associated with understanding and caring for the cocaine-exposed newborn.

Deficits in sustained attention and impulsivity have previously been demonstrated in preschoolers prenatally exposed to cocaine. We assessed an additional component of attention, selective attention, in a large, poly-substance cocaine-exposed cohort of 4 year olds and their at-risk comparison group. Employing postpartum maternal report and biological assay, we assigned children to overlapping exposed and complementary control groups for maternal use of cocaine, alcohol, marijuana, and cigarettes. Maternal pregnancy use of cocaine and use of cigarettes were both associated with increased commission errors, indicative of inferior selective attention. Severity of maternal use of marijuana during pregnancy was positively correlated with omission errors, suggesting impaired sustained attention. Substance exposure effects were independent of maternal postpartum psychological distress, birth mother cognitive functioning, current caregiver functioning, other substance exposures and child concurrent verbal IQ.

Publisher Summary This chapter discusses prenatal drug exposure and mental retardation. Prenatal exposure to cocaine is a behavioral teratogen. The early “rush to judgement” that occurred with crack cocaine can be replaced by sound research. As is evident from studies of cocaine exposure, even in cases where no birth defects are obvious, long-term follow-up may be needed to detect and ameliorate neurobehavioral effects. At both the individual and the societal levels, even in situations where etiology and pathogenesis are well-known, developmental disorders such as mental retardation do not emerge as a result of a single factor or at a single point in development. Neither a prenatal teratogenic environment nor a postnatal rearing environment model of development following prenatal cocaine exposure has total explanatory power. At each stage in development, the human brain is uniquely susceptible to exposure of teratogenic compounds. It is also readily apparent that prevention and treatment of conditions arising from exposure to teratogenic substances will be largely dictated by the stage or stages in which the exposure occurs. The chapter discusses several drawbacks of the traditional etiological classification of mental retardation—prenatal, perinatal, or postnatal.

In this study we proposed and tested the theory that behavior is affected by the orientation of the members of one's social network. We collected data from 98 women (some drug users) with the Orientation of Social Support (OSS) scale and two other widely used measures: the Social Support Questionnaire (SSQ), and the Multidimensional Scale of Perceived Social Support (MSPSS). Drug use was measured with the Addiction Severity Index (ASI). Pairwise correlations showed that the OSS had no correlation with the SSQ or the MSPSS. Subjects' ASI scores were regressed on the three measures of support. The only variable that entered stepwise regression was the OSS scale. This study confirmed our theory that it is important to examine the orientation of and not just the extent of social support. The paper provides the questionnaire and the scoring procedures for measurement of extent of peer pressure.

A basic problem encountered by investigations of prenatal cocaine effects has been the valid identification and quantification of exposure. Based on a combination of sources: (a) medical record review, (b) maternal urine toxicology screen, (c) meconium analysis, and (d) maternal postpartum interview, drug exposure status of 415 infants was established. Using this combination as a benchmark, maternal postpartum interview was found most sensitive, while medical record review was slightly less accurate. Meconium analysis and urine screens both demonstrated miss rates greater than the interview or record review methods. Meconium analysis and postpartum interview, however, each detected cases of cocaine exposure that the other had missed. Correlations between the amount of cocaine found in meconium and in maternal report indicated that the cocaine metabolite benzoylecgonine was the best biological marker. Quantifying heavy versus light exposure required a combination of both meconium analysis and maternal postpartum interview techniques.

This chapter presents an overview of current interventions aimed at addressing the needs of three groups of high-risk infants: infants born after fetal exposure to maternal substance abuse, infants with chronic illnesses diagnosable in infancy, and pre-term infants with low and very low birth weights. For each subgroup, the population and its associated problems, issues pertaining to practice with these populations, and innovations in practice and/or service delivery are discussed.

This study investigated early neonatal visual preferences in 267 poly drug exposed neonates (131 cocaine-exposed and 136 non-cocaine exposed) whose drug exposure was documented through interviews and urine and meconium drug screens. Infants were given four visual recognition memory tasks comparing looking time to familiarized stimuli of lattices and rectangular shapes to novel stimuli of a schematic face and curved hourglass and bull's eye forms. Cocaine-exposed infants performed more poorly, after consideration of confounding factors, with a relationship of severity of cocaine exposure to lower novelty score found for both self-report and biologic measures of exposure. Findings support theories which link prenatal cocaine exposure to deficits in information processing entailing attentional and arousal organizational systems. Neonatal visual discrimination and attention tasks should be further explored as potentially sensitive behavioral indicators of teratologic effects.

When one thinks of exceptionality, ideas such as “above average” or “varying from standard and typical norms” come to mind. In the area of behavioral teratology (the study of the effects of prenatal exposure to substances on developmental processes), the usual focus is also on how individuals deviate or vary from normative development. These effects are primarily pervasive and adverse in nature. It is important for readers to realize that the research described here entails effects not amenable to transient, environmental, or situational determinants of development (e.g., examining educational settings and promotion of giftedness), and that individuals who have been prenatally exposed to harmful agents display enduring, atypical developmental behaviors. Thus, exceptionality here is based on the premise that individuals do not undergo normal, typical developmental processes in the same fashion as those who were prenatally free from exposure to teratogenic agents.

Maternal cocaine use during pregnancy can affect the infant directly through toxic effects or indirectly through cocaine's influence on maternal psychological status. We followed 160 cocaine exposed and 56 nonexposed infants and their mothers identified at birth through interview and/or urine screen. Although cocaine exposure defined the groups, infant exposure to alcohol, marijuana, and tobacco was allowed to vary. Infants were 99% African American and poor. All mothers completed the Brief Symptom Inventory (BSI) and infants were given the Bayley Scales of Mental (MDI) and Motor (PDI) Development at a mean corrected age of 17 ± 8 months. Both MDIs (94 ± 17 vs. 103 ± 16) and PDIs (101 ± 16 vs. 108 ± 12) were lower for cocaine exposed infants. Psychological distress was greater in cocaine using mothers. Hierarchical multiple regression was used to assess the relative effects of gestational age, maternal psychological distress, and cocaine and polydrug exposure on infant outcomes. Both psychological distress and cocaine and alcohol exposure predicted lower MDIs after controlling for prematurity. Neither psychological distress nor alcohol exposure predicted motor outcome, while cocaine had a significant effect. Tobacco and marijuana exposure were unrelated to outcome. These findings provide further support for direct effects of cocaine and alcohol on infant development, as well as highlight the need for studies to document maternal psychological factors, which may increase child risk for poorer outcomes.

CONTEXT: Because of methodological limitations, the results of the few prospective studies assessing long-term cognitive effects of prenatal cocaine exposure are inconsistent. OBJECTIVE: To assess effects of prenatal cocaine exposure and quality of caregiving environment on 4-year cognitive outcomes. DESIGN: Longitudinal, prospective, masked comparison cohort study from birth (September 1994-June 1996) to 4 years. SETTING: Research laboratory of a US urban county teaching hospital. PARTICIPANTS: A total of 415 consecutively enrolled infants identified from a high-risk population screened for drug use through clinical interview, urine, and meconium screens. Ninety-three percent retention for surviving participants at 4 years of age resulted in 376 children (190 cocaine-exposed and 186 nonexposed). MAIN OUTCOME MEASURE: The Wechsler Preschool and Primary Scales of Intelligence-Revised. RESULTS: After control for covariates, prenatal cocaine exposure was not related to lower full-scale IQ (cocaine exposed [80.7] vs nonexposed [82.9]; P=.09) scores or summary verbal (cocaine exposed [79.9] vs nonexposed [81.9]; P=.11) or performance (cocaine exposed [85.5] vs nonexposed [87.5]; P=.18) IQ scores at age 4 years. However, prenatal cocaine exposure was related to small but significant deficits on several subscales (mean [SE]): visual-spatial skills (cocaine exposed [7.3 (0.22)] vs nonexposed [8.2 (0.22)]; P=.01), general knowledge (cocaine exposed [6.1 (0.18)] vs nonexposed [6.7 (0.17)]; P=.04), and arithmetic skills (cocaine exposed [6.2 (0.20)] vs nonexposed [6.8 (0.20)]; P=.05). Prenatal cocaine exposure was also associated with a lower likelihood of achievement of IQ above normative means (odds ratio, 0.26 [95% confidence interval, 0.10-0.65]; P=.004). The quality of the caregiving environment was the strongest independent predictor of outcomes. Cocaine-exposed children placed in nonrelative foster or adoptive care lived in homes with more stimulating environments and had caregivers with better vocabulary scores, and they attained full-scale and performance IQ scores (83 and 87, respectively) similar to nonexposed children in biological maternal or relative care (full-scale IQ, 82; performance IQ, 88) and higher than cocaine-exposed children in biological maternal or relative care (full-scale IQ, 79; performance IQ, 84). CONCLUSIONS: Prenatal cocaine exposure was not associated with lower full-scale, verbal, or performance IQ scores but was associated with an increased risk for specific cognitive impairments and lower likelihood of IQ above the normative mean at 4 years. A better home environment was associated with IQ scores for cocaine-exposed children that are similar to scores in nonexposed children.

We compared the maternal behaviors of women who had extended and early contact (rooming-in) with their infants with those who had contact only during feedings. Thirty-one young, unmarried, predominantly black, lower-socioeconomic mothers and their infants were observed in the mother's hospital room for 15 minutes after a morning feeding approximately 18 hours after delivery. A time sample unit checklist was used to record each mother's behavior, looking, talking, and touching directed toward their infants and others, as well as watching television and talking on the telephone. Analyses of variance revealed that the rooming-in mothers looked at, talked to, and touched their infants more, watched less television, and talked less on the telephone than mothers with minimal contact with their infants. These findings suggest that increased postpartum contact with infants leads not only to more interaction, but also to more touching as well as touching in more intimate places (face and head), thus highlighting the value of rooming-in arrangements for mothers and infants.

This study examined the health-related quality of life (HRQOL) of children with Inflammatory Bowel Disease (IBD) compared with physically healthy children and the impact of IBD and steroidal side-effects on children's HRQOL. The HRQOL of 49 children and adolescents (ages 10 to 18 years) with IBD and their parents who completed the Child Health Questionnaire was compared to that of a sample of physically healthy children (N=49). Caregivers of children with IBD reported that their children's physical and psychological health were more limited and that they experienced more emotional worry and greater impact on their personal time compared to caregivers reporting on healthy same-age children. Children and adolescents reported worse HRQOL than physically healthy children in only one domain: general health. Children and adolescents with more IBD-related and steroidal symptoms had less adequate HRQOL as reported by their parents. Limitations in HRQOL were most pronounced in children who experienced more frequent IBD-related symptoms together with symptoms of steroidal side effects.

Prenatal cocaine exposure may have long-term negative effects on child developmental outcomes, but prior studies have been contradictory. We followed 408 infants (212 cocaine-exposed (CE) and 196 non-exposed (NCE)) to 6.5 and 12 months of age, administering the Bayley Mental (MDI) and Motor (PDI) Scales and, in a subset, the Preschool Language Scale (PLS). Maternal self-report interviews and infant meconium analyses quantified severity of cocaine exposure. Based on this drug information the cocaine-exposed infants were subdivided into heavy and light exposed groups. Bayley MDI's were lower for CE infants at 6 months (96 ± 8 vs. 98 ± 8, t (335) =-.2.3, p

In 276 infants (132 cocaine-exposed and 144 non-exposed) recruited into a longitudinal study of fetal cocaine exposure at birth, standardized clinical interviews, urine screens, and meconium assays were used to assess the relationship of cocaine and polydrug exposure to infant birth and neonatal neurobehavioral outcomes. Clinical interviews yielded maternal self-report of frequency and severity of cocaine, alcohol, marijuana and tobacco use while pregnant. Meconium assays measured cocaine and its metabolites; cocaine (COC), Benzoylecgonine (BEN), M-O-H Benzoylecgonine (MOH), and cocaethylene (COCETH); marijuana (THC), and tobacco (COT). In addition to measuring birth parameters, Gardner's Neurobehavioral (NB) Assessment was administered at 2 weeks(corrected ages). In regressions controlling for alcohol, marijuana, and tobacco use, and GA if warranted, maternal report of higher frequency of days of cocaine use predicted lower infant BW (p